Phosgene Oxime Exposure Treatment & Management

  • Author: Erik D Schraga, MD; Chief Editor: Robert G Darling, MD, FACEP   more...
 
Updated: Feb 9, 2011
 

Prehospital Care

  • The key aspects of prehospital care are removal of casualties from the source of exposure and rapid decontamination. Decontamination consists of removal of all clothing, wiping all gross materials from skin, rinsing with copious amounts of soap and water, washing with 0.5% hypochlorite solution, or use of resin compounds.
  • Administer oxygen to patients with significant respiratory distress. Endotracheal intubation and ventilatory support may be required for patients with severe airway exposures or progressive pulmonary symptoms.[9, 10]
  • Administer sufficient doses of systemic analgesics as soon as possible.
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Emergency Department Care

Emergency department care is a continuation of prehospital care and is supportive in nature. No antidotes exist for phosgene oxime exposure. Although corticosteroid treatment has been given to patients exposed to chlorine gas, which causes a similar syndrome, evidence is limited on its efficacy and safety in the treatment of phosgene exposure.[5, 9, 10] Verify complete decontamination to ensure that no medical personnel become casualties.

Airway and/or pulmonary [8]

Be alert to the possible need for airway management in patients with severe exposure.

Administer oxygen to patients with significant respiratory symptoms.

Provide supportive care for noncardiogenic pulmonary edema as required.

Pain management

Pain associated with CX exposure is nearly unbearable. Ensure that adequate systemic, preferably parenteral, analgesics are administered.

Eyes

Apply topical antibiotics to reduce risk of infection and adhesions.

Topical anticholinergics may reduce the risk of future synechiae formation.

Skin

Initiate wound management as appropriate for any other necrotic and/or ulcerated lesion.

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Consultations

  • Consult ophthalmology to provide close follow-up care for significant ocular exposures.
  • Consult plastic surgery for severe dermal damage.
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Contributor Information and Disclosures
Author

Erik D Schraga, MD  Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Coauthor(s)

Andre Pennardt, MD, FACEP, FAAEM, FAWM  Clinical Associate Professor of Emergency Medicine, Medical College of Georgia; Assistant Professor of Military and Emergency Medicine, Uniformed Services University of the Health Sciences; Consulting Staff, Departments of Emergency Medicine, Aviation Medicine and Dive Medicine, Womack Army Medical Center

Andre Pennardt, MD, FACEP, FAAEM, FAWM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Association of Military Surgeons of the US, International Society for Mountain Medicine, National Association of EMS Physicians, Special Operations Medical Association, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Fred Henretig, MD  Director, Section of Clinical Toxicology, Professor, Medical Director, Delaware Valley Regional Poison Control Center, Departments of Emergency Medicine and Pediatrics, University of Pennsylvania School of Medicine, Children's Hospital

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Rick Kulkarni, MD 

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Robert G Darling, MD, FACEP  Adjunct Clinical Assistant Professor of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine; Associate Director, Center for Disaster and Humanitarian Assistance Medicine

Robert G Darling, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Telemedicine Association, and Association of Military Surgeons of the US

Disclosure: Nothing to disclose.

References

  1. Armstrong J. Chemical warfare. RN. Apr 2002;65(4):32-9. [Medline].

  2. Dang C. Chemical warfare agents. Top Emerg Med. 2002;24(2):25-39.

  3. McManus J, Huebner K. Vesicants. Crit Care Clin. Oct 2005;21(4):707-18, vi. [Medline].

  4. Rosenbloom M, Leikin JB, Vogel SN, Chaudry ZA. Biological and chemical agents: a brief synopsis. Am J Ther. Jan-Feb 2002;9(1):5-14. [Medline].

  5. Department of the Army. Phosgene oxime. In: Field Manual 8-285: Treatment of Chemical Agent Casualties and Conventional Military Chemical Injuries. 1995:IV-17-22.

  6. Zajtchuk R, Bellamy RF, eds. Phosgene oxime. In: Textbook of Military Medicine Part I: Medical Aspects of Chemical and Biological Warfare. 1997:220-222.

  7. McAdams AJ Jr, Joffe MH. A Toxico-pathologic Study of Phosgene Oxime. 1955. Army Medical Laboratories Research Report 381.

  8. Russell D, Blain PG, Rice P. Clinical management of casualties exposed to lung damaging agents: a critical review. Emerg Med J. Jun 2006;23(6):421-4. [Medline].

  9. ATSDR. Medical management guidelines for phosgene oxime. [Full Text].

  10. USAMRICD. Phosgene oxime. In: Medical Management of Chemical Casualties Handbook. 3rd ed. 2000:96-101.

 
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Anteroposterior portable chest radiograph in a male patient who developed phosgene-induced adult respiratory distress syndrome. Notice the bilateral infiltrates and ground glass appearance.
Chemical Terrorism Agents and Syndromes. Signs and symptoms. Chart courtesy of North Carolina Statewide Program for Infection Control and Epidemiology (SPICE), copyright University of North Carolina at Chapel Hill, www.unc.edu/depts/spice/chemical.html.
 
 
 
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